anxiety

differential diagnosis of generalized anxiety disorder

diagnostic algorithm

neurotic disorders

principles of treatment for generalized anxiety disorder

therapy algorithm

treatment of anxiety disorders

psychopharmacotherapy

psychotherapy of neurotic disorders.

List of abbreviations

BP - blood pressure

ALT - alanine aminotransferase

AST - aspartate aminotransferase

GAD - Generalized Anxiety Disorder

ITT - integrated test of anxiety

ICD - international classification of diseases

MRI - Magnetic Resonance Imaging

MRI - Magnetic Resonance Imaging

RCTs - randomized clinical trials

SSRIs - selective serotonin reuptake inhibitors

SNRIs - selective serotonin and norepinephrine reuptake inhibitors

T3 - triiodothyronine

T4 - thyroxine

TSH - thyroid stimulating hormone

TCDG - transcranial dopplerography

USK - a technique for determining the level of subjective personality control

BAI (The Beck Anxiety Inventory)

COPE (Coping) - coping behavior technique

DSM - diagnostic and statistic manual of mental disorders - diagnostic manual of mental disorders

HARS (The Hamilton Anxiety Rating Scale) - Hamilton's anxiety scale

IIP (Inventory of Interpersonal Problems) - Questionnaire for the study of interpersonal problems

ISTA (ch Struktur Test nach G. Ammon) - Methodology "I-structural test" G. Ammon, I. Burbil

LSI (Life style index) - methodology "Life style index"

MDMQ (Melbourne decision making questionnaire) - Melbourne decision making questionnaire

MMPI (Minnesota Multihasic Personality Inventory) - Standardized Clinical Personality Inventory

MPS (Multidimensional perfectionism scale) - Multidimensional scale of perfectionism

SCL-90-R ((Symptom Check List-90- Revised) - Questionnaire for the severity of psychopathological symptoms

ShARS (Sheehan Anxiety Scale) - Sheehan Anxiety Scale

STAI (State-Trait Anxiety Inventory) - Spielberger's anxiety scale

** VED - the drug is included in the list of "Vital and Essential Medicines"

# - this disease or disorder is not indicated in the instructions for use

Terms and Definitions

Anxiety- negatively colored emotion, expressing a feeling of uncertainty, expectation of negative events, hard-to-define premonitions. Unlike the causes of fear, the causes of anxiety are usually not recognized, but it prevents a person from engaging in potentially harmful behavior, or prompts him to take action to increase the likelihood of a successful outcome of events.

Psychopharmacotherapy is the use of psychotropic drugs in the treatment of mental disorders.

Psychotherapy- This is a system of therapeutic effects on the human psyche, and through the psyche and through it on the entire human body.

1. Brief information

1.1 Definition

Generalized anxiety disorder(GAD) - widespread and persistent anxiety and tension, not limited or caused mainly by any special environmental circumstances ("free floating anxiety"). The disease is characterized by a chronic or recurrent course and can lead to severe maladjustment and an increased suicidal risk.

1.2 Etiology and pathogenesis

Among the risk factors for the onset of GAD are:

Personal characteristics - restrained behavior in an unfamiliar situation, negative affectivity and increased caution, avoidance of possible real or imagined harm, are factors associated with GAD.

Social factors - although among patients with GAD, upbringing according to the type of hyperprotection and psycho-traumatic influences in childhood is more common, today no specific psychosocial factor has been identified that has a connection with the manifestation of GAD.

Genetic and physiological factors - the role of genetic factors for GAD is about 30%, however, these same genetic factors determine negative affectivity and affect the manifestation of other affective disorders, especially depressive. It is believed that the genetic risk of fucking women is twice that of men.

GAD remains the least studied of all anxiety disorders due to its high comorbidity with other mood disorders. Currently, data have been obtained on the role of excessive activity of the noradrenergic system and low density of benzodiazepine receptors in the pathogenesis of GAD. The role of the immune system is also being explored, given that persistent anxious rumination can promote the release of cytokines and maintain "smoldering inflammatory responses" in the body.

Among the psychological theories of GAD, one of the most popular is the metacognitive theory, according to which in patients with GAD, metacognitive functioning associated with the observation and assessment of their own cognitive processes is dominated by the idea of ​​protective and reality-controlling functions of excessive anxiety and a catastrophic scenario. The fact that most negative scenarios associated with the future are not realized in this case serves as a positive reinforcement and contributes to adherence to the anxious metacognitive model.

The psychodynamic approach indicates that the experience of separation from a significant other personifying safety and the absence of a stable or predominance of an anxious attachment model in early childhood leads to a deficit in the personality structure, which determines the predominance of free floating, non-abusive anxiety over situational anxiety, problems in the differentiation of mental and somatic sensations and regulation of affective tension, which creates a predisposition for the manifestation of GAD.

1.3 Epidemiology

Lifetime prevalence of GAD ranges from 0.1% to 8.5% and averages about 5% of cases in the adult population. Among other anxiety disorders, it accounts for a significant proportion - from 12 to 25%.

1.4 Coding according to ICD-10

F41.1 - Generalized anxiety disorder

1.5 Classification

GTR classification:

Chronic generalized disorder

Recurrent generalized disorder

1.6 Clinical picture

Generalized anxiety:

Lasts at least 6 months;

Captures various aspects of the patient's life, circumstances and activities;

Aimed primarily at upcoming events;

Uncontrollable, it is impossible to suppress it by an effort of will or rational belief;

Disproportionate to the patient's current life situation;

It is often accompanied by feelings of guilt.

The clinical picture is presented mainly by three characteristic groups of symptoms of GAD:

1. Anxiety or apprehension that is difficult for the patient to control and that lasts longer than usual. This anxiety is generalized and does not focus on specific issues, such as the possibility of an anxiety attack (as in panic disorder), being stranded (as in social phobia), or contaminated (in obsessive-compulsive disorder).

Other mental symptoms of GAD are irritability, poor concentration, and sensitivity to noise.

1. Motor tension, which can manifest itself as muscle tension, tremors, inability to relax, headache (usually bilateral and often in the frontal and occipital regions), aching muscle pains, muscle stiffness, especially back and shoulder muscles.
2. Hyperactivity of the autonomic nervous system, which is expressed by increased sweating, tachycardia, dry mouth, epigastric discomfort and dizziness and other symptoms of autonomic arousal.

Table 1.

Characteristic manifestations of GAD

Factors indicating a more favorable prognosis: late onset of the disorder; insignificant severity of social maladjustment; gender - women are more prone to remission.

Factors indicating a poor prognosis: poor relationship with a spouse or relatives; the presence of comorbid mental disorders; gender - men are less prone to remission

Comorbidity of GAD with other mental disorders:

Comorbidity is a hallmark of GAD. Over 90% of all patients with a primary diagnosis of generalized anxiety disorder had another mental disorder during their lifetime.

The most common comorbidity with the following mental disorders:

endogenous depression, recurrent depressive disorder;

bipolar disorder;

dysthymia;

alcohol addiction;

simple phobias;

social phobia;

obsessive compulsive disorder;

drug addiction;

psychopathologically undifferentiated chronic fatigue syndrome;

asthenic disorders.

Associated with somatic pathology.

There is a high prevalence of certain medical conditions in patients with anxiety disorders:

cardiovascular diseases;

gastrointestinal diseases;

respiratory disorders;

• allergic diseases;

  metabolic pathology;

  back pain.

2. Diagnostics

2.1 Complaints and anamnesis

Main complaints: constant, "free-floating" anxiety, somatovegetative disorders.

2.2 Physical examination

2.3 Laboratory diagnostics

It is recommended to conduct a general blood test with a study of the leukocyte formula, a biochemical blood test: total protein, albumin, urea, creatinine, alanine aminotransferase (ALT), aspartate aminotransferase (AST), bilirubin, a study of blood electrolytes (sodium, potassium, chlorine), a general urine test.

2.4 Instrumental diagnostics

2.5 Experimental psychological diagnostics

Symptom Check List-90-Revised (SCL-90-R); The Beck Anxiety Inventory (BAI); The Hamilton Anxiety Rating Scale (HARS) ); State-Trait Anxiety Inventory (STAI); Integrative Anxiety Test (ITT); Shihan Anxiety Scale (ShARS), GAD Screening Scale).

It is recommended to use methods for the psychological structure of personality (Standardized clinical personality questionnaire MMPI (adapted by I.N. Gilyasheva, L.N. Ammona (ISTA), I. Bourbil (2003)).

It is recommended to use methods for the study of individual individual psychological personality traits (Methodology for determining the level of subjective personality control (USC); Questionnaire for the study of personal beliefs "Personal Beliefs Test" (Kassinove H., Berger A., ​​1984); Multidimensional scale of perfectionism (Multidimensional perfectionism scale - MPS)).

It is recommended to use methods for psychological diagnosis of risk factors for mental maladjustment (Life style index methodology; E. Heim methodology (1988) to determine the nature of coping behavior; Coping behavior methodology (COPE); Melbourne decision-making questionnaire (Melbourne decision making questionnaire, - MDMQ).

It is recommended to use methods for psychological diagnostics of the system of significant relationships (Inventory of Interpersonal Problems (IIP); Methodology for the study of the severity of intrapersonal conflicts, developed by S. Leder et al. (1973)).

2.6 Differential diagnosis

GAD needs to be differentiated from the following disorders:

Social phobia;

Specific phobia;

Obsessive compulsive disorder;

Post-traumatic stress disorder;

Panic disorder;

Mood disorders (endogenous depression, recurrent depressive disorder, bipolar disorder, dysthymia);

Somatoform disorders;

Schizophrenia (paranoid, sluggish), schizotypal disorder;

Personality disorders (hysterical, anankastic, anxious, emotionally labile);

Residual organic diseases of the brain;

Organic brain diseases;

Hypothalamic disorder;

Thyroid pathology;

Pheochromocytoma;

The use of psychoactive substances (for example, amphetamines, cocaine, etc.);

Cancellation of benzodiazepines.

3. Treatment

3.1 Conservative treatment

3.1.1 Psychopharmacotherapy

Selective serotonin reuptake inhibitors (SSRIs) (paroxetine **, escitalopram #, sertraline ** #) and selective serotonin and norepinephrine reuptake inhibitors (SSRIs) (venlafaxine #, duloxetine #) are predominantly recommended as first-line drugs. The effects of tricyclic antidepressants (clomipramine ** #) have been proven.

The anxiolytic effect of pregabalin ** has been confirmed, its effect on the mental, somatic and vegetative components of anxiety, as well as good tolerance and a high level of safety. Its use is recommended for GAD.

The use of short-term benzodiazepines (diazepam ** #, lorazepam **, phenazepam ** #) is recommended. The duration of use is limited by significant undesirable effects - sedation, decreased concentration of attention and memorization, impaired psychomotor functions, the risk of dependence formation, a pronounced withdrawal syndrome, manifested by a worsening of the condition and increased anxiety after stopping the intake and therefore should be limited to short courses (no more than 2-3 weeks) ...

The recommended duration of therapy for generalized anxiety disorder is at least 6 months after the onset of the therapeutic effect of the applied therapy, however, in most cases, a longer period of treatment is advisable.

Possible side effects of psychopharmacotherapy for generalized anxiety disorder. When using psychotropic drugs, it is recommended to take into account the following side effects: drowsiness, lethargy, urinary retention, constipation or diarrhea, nausea, headaches, dizziness. At the same time, adequate dosages and prescriptions of drugs strictly according to indications significantly reduce the risk of side effects.

An assessment of the effectiveness and tolerance of therapy is recommended, which is carried out on days 7-14-28 of psychopharmacotherapy and then once every 4 weeks until the end of the course of treatment. In case of intolerance or insufficient effectiveness, dosage adjustment or drug change is carried out.

3.1.2 Psychotherapy

Contraindications to psychotherapeutic treatment:

1) patients with a fear of self-disclosure and a strong reliance on "denial" as a form of psychological defense;

2) patients with insufficient motivation to change;

3) patients with low interpersonal sensitivity;

4) patients who will not be able to attend all classes;

5) patients who will not participate in the process of active verbalization and listening, which is an essential part of any group;

6) patients whose personality traits will not allow them to work constructively in a group and benefit from this work (who constantly act out their emotions outwardly as a defensive reaction, and do not observe their psychological state; or patients with serious negativism or rigidity).

Family, socio-psychological, professional are recommended as special types of rehabilitation.

Supportive psychotherapy is recommended as one of the important forms of rehabilitation measures, which can be carried out on an outpatient basis in the form of individual and group psychotherapy.

5. Prevention and dispensary observation

6. Additional information affecting the course and outcome of the disease

6.1 Factors (predictors) contributing to a protracted course

Main predictors of prolonged GAD course

Criteria for assessing the quality of medical care

Quality criteria

Confidence level of evidence

Stage of diagnosis

Examined by a psychiatrist

Suicidal risk assessment completed

An experimental psychological examination was performed

Performed a biochemical general therapeutic blood test (total protein, albumin, urea, creatinine, alanine aminotransferase, aspartate aminotransferase, bilirubin, blood electrolytes (sodium, potassium, chlorine))

General urine analysis performed

The level of thyroid-stimulating hormone and triiodothyronine and thyroxine was determined

Electroencephalography performed

Transcranial Doppler ultrasonography performed

Electrocardiography performed

Stage of treatment

Appointment of psychopharmacotherapy completed

Psychotherapy performed

Evaluation of the effectiveness and tolerability of the prescribed therapy was carried out (on days 7-14-28 and then monthly)

A change of therapy was performed in the absence of efficacy or intolerance to therapy

Achieved a decrease in somatic anxiety indicators on the Hamilton anxiety scale

Achieved a decrease in the indicators of mental anxiety on the Hamilton scale

Achieved improvement in the severity of psychopathological appearances on the SCL-90 scale not less than average

Bibliography

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Churkin A.A. Results of an epidemiological study of the prevalence of GAD among the population of a large industrial city. Report at the experimental meeting on the diagnosis and therapy of GAD 25.03.2010.

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Behar, E., Borkovec, T.D. (2005). The nature and treatment of generalized anxiety disorder. In: B.O. Rothbaum (Ed.), The nature and treatment of pathological anxiety: essays in honor of Edna B. Foa (pp. 181-196). New York: Guilford.

Borkovec, T.D., Inz, J. (1990). The nature of worry in generalized anxiety disorder /. Behavior Research and Therapy 28,153-158.

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Diefenbach, G. J., Stanley, M. A. Beck, J. G. (2001). Worry content reported by older adults with and without generalized anxiety disorder. Aging and Mental Health, 5, 269-274.

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Hoehn-Saric, M. D., McLeod, D. R., Funderburk, F. Kowalski, P. (2004). Somatic symptoms and physiologic responses in generalized anxiety disorder and panic disorder. An ambulatory monitor study. Archives of General Psychiatry, 61, 913-921.

Holaway, R. M., Rodebaugh, T. L., Heimberg, R. G. (2006). The epidemiology of worry and generalized anxiety disorder. In G.C.L. Davey, A. Wells (Egs.), Worry and its psychological disorder: Theory, assessment and treatment (pp. 3-20). Chichester: Wiley.

Lieb R., Becker E., Almatura C. The epidemiology of generalized anxiety disorder in Europe. European Neuropsychopharmacology, (15) 2005, pp. 445-452.

Mennin, D. S., Heimberg, R. G., Turk, C. L., Fresco, D. M. (2005). Preliminary evidence for an emotion dysregulation model of generalized anxiety disorder. Behavior Research and Therapy 43,1281-1310.

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Yonkers K. A., Dyck I. R., Warshaw M. G. Keller M. B. (2000). Factors predicting the clinical course of generalized anxiety disorder. British Journal of Psychiatry, 176, 544-549.

Appendix A1. Composition of the working group

1. Vasilyeva Anna Vladimirovna - Doctor of Medical Sciences, Associate Professor, Leading Researcher of the Department of Borderline Mental Disorders and Psychotherapy Federal State Budgetary Institution “St. V.M. Bekhterev "of the Ministry of Health of the Russian Federation.
2. Karavaeva Tatyana Arturovna - Doctor of Medical Sciences, Associate Professor, Chief Researcher, Head of the Department of Borderline Mental Disorders and Psychotherapy Federal State Budgetary Institution “St. V.M. Bekhterev "of the Ministry of Health of the Russian Federation.
3. Mizinova Elena Borisovna - PhD in Psychology, Senior Researcher, Department of Borderline Mental Disorders and Psychotherapy, Federal State Budgetary Institution “St. V.M. Bekhterev "of the Ministry of Health of the Russian Federation.
4. Poltorak Stanislav Valerievich - Candidate of Medical Sciences, Leading Researcher of the Department of Borderline Mental Disorders and Psychotherapy Federal State Budgetary Institution “St. V.M. Bekhterev "of the Ministry of Health of the Russian Federation.
5. Bukreeva ND, Doctor of Medical Sciences, Head of the Scientific and Organizational Department of the Federal State Budgetary Institution "FMITSPN im. VP Serbsky ";
6. Rakityanskaya E.A., Candidate of Medical Sciences, Senior Researcher of the Scientific and Organizational Department of the Federal State Budgetary Institution "FMITsPN im. VP Serbsky ";
7. R.V. Kutueva, Junior Researcher of the Scientific and Organizational Department of the Federal State Budgetary Institution "FMITsPN im. VP Serbsky ".

Conflict of interest missing.

1. Psychiatrists
2. Psychotherapists
3. Clinical psychologists
4. General practitioners

Table P1- Evidence confidence levels

Table P2- Levels of persuasiveness of recommendations

Appendix A3. Related documents

Order No. 1225n "On approval of the standard of primary medical and social care for neurotic, stress-related and somatoform disorders, generalized anxiety disorder in the outpatient setting of a neuropsychiatric dispensary (dispensary department, office)" dated 20.12.2012.

Order No. 1229n "On approval of the standard of specialized medical care for neurotic, stress-related and somatoform disorders, generalized anxiety disorder" dated 20.12.2012.

Appendix B. Patient management algorithms

Algorithm for managing patients with generalized anxiety disorder

Appendix B. Information for Patients

What are Anxiety Disorders?

Anxiety disorders are a group of diseases of the nervous system, the main manifestation of which is a persistent feeling of anxiety, arising for insignificant reasons or for no reason at all.

What are the main symptoms of anxiety disorders?

Unreasonable feeling of anxiety, difficulty breathing, dizziness, fear of death or imminent catastrophe, pain in the chest or abdomen, feeling of "lump in the throat", etc.

Diagnosis of anxiety disorders.

Usually, the diagnosis of anxiety disorder is made after ruling out all diseases that may exhibit similar symptoms. The diagnosis and treatment of anxiety disorders and panic attacks is the responsibility of a psychotherapist and psychiatrist.

A preliminary diagnosis can be made by a general practitioner, a neuropathologist.

Anxiety treatment.

Treatment for anxiety disorders includes psychotherapy and medication to reduce anxiety (anxiolytics).

Psychotherapy includes various techniques that help a patient with an anxiety disorder to correctly assess the situation, to achieve relaxation during an anxiety attack. Psychotherapy can be done individually or in small groups. Learning how to behave in different situations helps you feel confident in your ability to cope with stressful situations.

Medication for anxiety disorders includes the use of various anxiety medications. Medicines that reduce feelings of anxiety are called anxiolytics (sedatives). Medication - the appointment, correction of therapy, cancellation of drugs is carried out only by a specialist doctor.

Appendix D.

Instruction. Below is a list of problems and complaints people sometimes have. Please read each paragraph carefully. Circle the number of the answer that most accurately describes how uncomfortable or anxious you have been about a problem over the past week, including today. Circle only one of the numbers in each paragraph (so that the number inside each circle is visible), without missing any paragraphs. If you want to change your report, cross out your first mark.

Full name __________________________________ Date ____________________

The key to the technique

Somatization SOM (12 items) - 1 4 12 27 40 42 48 49 52 53 56 58

Obsessive-compulsive O-C (10 points) - 3 9 10 28 38 45 46 51 55 65

Interpersonal anxiety INT (9 points) - 6 21 34 36 37 41 61 69 73

Depression DEP (13 points) - 14 15 20 22 26 29 30 31 32 54 56 71 79

Anxiety ANX (10 points) - 2 17 23 33 39 57 72 78 80 86

Hostility HOS (6 points) - 11 24 63 67 74 81

Phobias PHOB (7 points) - 13 25 47 50 70 75 82

Paranoia PAR (6 points) - 8 18 43 68 76 83

Psychoticism PSY (10 points) - 7 16 35 62 77 84 85 87 88 90

Additional points of Dopoln (7 points) - 19 44 59 60 64 66 89

Processing of the received data

1. Points on each scale - 9 indicators. Divide the sum of points for each scale by the number of points in this scale. For example, the sum of points on the 1st scale is divided by 12, on the 2nd - by 10, etc.
2. The overall score is the GSI (General Symptomatical Index) index. Divide the total of all points by 90 (number of items in the questionnaire).
3. Positive Symptomatical Index (PSI). The number of points for which a score from 1 to 4 is given is counted.
4. PDSI (Positive Distress Symptomatical Index). The GSI index is multiplied by 90 and divided by the PSI index.

Description of scales

1. Somatization. Items included in this scale reflect the distress arising from the realization of impaired body functions. The parameter includes complaints about the cardiovascular, gastrointestinal, respiratory and other systems. If the organic basis of complaints is excluded, a variety of somatoform disorders and anxiety equivalents are recorded.
2. Obsessive-Compulsive. The core of this scale is the clinical syndrome of the same name. Includes clauses indicating the repetition and undesirability of certain phenomena, as well as the presence of more general cognitive difficulties.
3. Interpersonal Sensitivity. The symptoms that form the basis of this scale reflect feelings of personal inadequacy and inferiority in social contacts. The scale includes items reflecting self-condemnation, feelings of awkwardness and pronounced discomfort in interpersonal interactions. Reflects a tendency towards reflection and low self-esteem.
4. Depression. Depression score items reflect a wide range of circumstances surrounding clinical depressive syndrome. Included are complaints of declining interest in the activity, lack of motivation and loss of vitality. The scale also includes items related to the idea of ​​suicide, feelings of hopelessness, worthlessness, and other somatic and cognitive characteristics of depression.
5. Anxiety. This scale includes a group of symptoms and reactions that are usually clinically associated with obvious (explicit) anxiety, reflecting a feeling of oppressive unreasonable inner anxiety. The basis of this scale is complaints of a feeling of nervousness, impatience and internal tension in combination with somatic, motor manifestations.
6. Hostility (Anger-Hostility). This parameter is formed from three categories of hostile behavior: thoughts, feelings and actions.
7. Phobias (Phobic Anxiety). Complaints on this scale reflect fears associated with travel, open spaces, public places, transportation, and phobic reactions of a social nature.
8. Paranoid Ideation. When creating this scale L.R. Derogatis et al. held the position that paranoid phenomena are better comprehended when they are perceived as a way of thinking. Paranoid thinking traits of paramount importance were included in the scale within the constraints imposed by the questionnaire. These are, first of all, projecting thinking, hostility, suspicion, attitude ideas.
9. Psychoticism. The basis of this scale is the following symptoms: auditory hallucinations, transmission of thoughts at a distance, external control of thought, and intrusion of thoughts from the outside. Along with these items, the questionnaire presents other indirect signs of psychotic behavior, as well as symptoms indicating a schizoid lifestyle.

Appendix D2. Hamilton scale for assessing anxiety

Instructions and text

The survey takes 20 - 30 minutes, during which the experimenter listens to the subject's answer on the topic of the question and assesses it on a five-point scale.

1. Anxious mood (anxiety, expectation of the worst, anxious fear, irritability).
2. Missing.
3. To a mild degree.
4. To a moderate extent.
5. To a severe degree.
6. To a very severe degree.

1. Tension (feeling of tension, flinching, easy tearfulness, trembling, feeling of anxiety, inability to relax).
2. Missing.
3. To a mild degree.
4. To a moderate extent.
5. To a severe degree.
6. To a very severe degree.

1. Fears (fear of the dark, strangers, animals, vehicles, crowds, fear of being alone).
2. Missing.
3. To a mild degree.
4. To a moderate extent.
5. To a severe degree.
6. To a very severe degree.

1. Insomnia (difficulty falling asleep, interrupted sleep, sleep that does not bring rest with a feeling of weakness and weakness upon awakening, nightmares).
2. Missing.
3. To a mild degree.
4. To a moderate extent.
5. To a severe degree.
6. To a very severe degree.

1. Intellectual impairments (difficulty concentrating, memory impairment).
2. Missing.
3. To a mild degree.
4. To a moderate extent.
5. To a severe degree.
6. To a very severe degree.

1. Depressive mood (loss of habitual interests, loss of a sense of pleasure from a hobby, depression, early awakenings, daily fluctuations in the state).
2. Missing.
3. To a mild degree.
4. To a moderate extent.
5. To a severe degree.
6. To a very severe degree.

1. Somatic symptoms (pain, muscle twitching, tension, myoclonic cramps, teeth grinding, breaking voice, increased muscle tone).
2. Missing.
3. To a mild degree.
4. To a moderate extent.
5. To a severe degree.
6. To a very severe degree.

1. Somatic symptoms (sensory - ringing in the ears, blurred vision, hot or cold flashes, feeling of weakness, tingling sensation).
2. Missing.
3. To a mild degree.
4. To a moderate extent.
5. To a severe degree.
6. To a very severe degree.
7. Cardiovascular symptoms (tachycardia, palpitations, chest pain, pulsation in the vessels, feeling of weakness, frequent sighing, dyspnea).
8. Missing.
9. To a mild degree.
10. To a moderate extent.
11. To a severe degree.
12. To a very severe degree.

1. Respiratory symptoms (feeling of pressure or tightness in the chest, feeling of suffocation, frequent sighing, dyspnea).
2. Missing.
3. To a mild degree.
4. To a moderate extent.
5. To a severe degree.
6. To a very severe degree.

1. Gastrointestinal symptoms (difficulty swallowing, flatulence, abdominal pain, heartburn, feeling of fullness in the stomach, nausea, vomiting, rumbling in the abdomen, diarrhea, weight loss, constipation).
2. Missing.
3. To a mild degree.
4. To a moderate extent.
5. To a severe degree.
6. To a very severe degree.

1. Genitourinary symptoms (frequent urination, strong urge to urinate, amenorrhea, menorrhagia, frigidity, premature ejaculation, loss of libido, impotence).
2. Missing.
3. To a mild degree.
4. To a moderate extent.
5. To a severe degree.
6. To a very severe degree.

1. Vegetative symptoms (dry mouth, redness of the skin, pallor of the skin, increased sweating, headaches with a feeling of tension).
2. Missing.
3. To a mild degree.
4. To a moderate extent.
5. To a severe degree.
6. To a very severe degree.

1. Behavior during examination (fidgeting in place, restless gestures or gait, hand tremors, frowning of eyebrows, tense facial expression, sighing or rapid breathing, pallor of the face, frequent swallowing of saliva, etc.).
2. Missing.
3. To a mild degree.
4. To a moderate extent.
5. To a severe degree.
6. To a very severe degree.

Anxious Mood - Anxiety, anticipation of the worst, anxious apprehension, irritability.

Voltage - Feeling of tension, flinching, easy tearfulness, trembling, feeling of anxiety, inability to relax.

Fears - Fear of the dark, strangers, animals, vehicles, crowds, fear of being alone.

Insomnia - Difficulty falling asleep, interrupted sleep, not restful sleep with a feeling of weakness and weakness on waking, nightmares .

Intellectual impairment - Difficulty concentrating, memory impairment.

Depressive mood - Loss of habitual interests, loss of a sense of pleasure from a hobby, depression, early awakenings, daily fluctuations in the state.

Somatic symptoms (muscle) - Pain, muscle twitching, tension, myoclonic cramps, teeth grinding, breaking voice, increased muscle tone.

Somatic symptoms (sensory) - Ringing in the ears, blurred vision, hot or cold flashes, weakness, tingling sensation.

Cardiovascular symptoms - Tachycardia, palpitations, chest pain, pulsation in the vessels, feeling of weakness, frequent sighing, dyspnea.

Respiratory Symptoms - A feeling of pressure or constriction in the chest, a feeling of suffocation, frequent sighing, dyspnea.

Gastrointestinal symptoms - Difficulty swallowing, flatulence, abdominal pain, a feeling of fullness in the stomach, nausea, vomiting, rumbling in the abdomen, diarrhea, weight loss, constipation.

Genitourinary Symptoms - Frequent urination, strong urge to urinate, amenorrhea, menorrhagia, frigidity, premature ejaculation, loss of libido, impotence.

Vegetative symptoms - Dry mouth, redness of the skin, pallor of the skin, increased sweating, headaches with a feeling of tension.

Examination Behavior - Fidgeting in place, restless gesticulation or gait, hand tremors, frowning, frowned facial expressions, sighing or rapid breathing, pallor of the face, frequent swallowing of saliva, etc.

Processing of the received data

The questionnaire is structured in such a way that the so-called "somatic anxiety" is measured on seven items, and "mental anxiety" on the other seven.

Interpretation

0-7 - no alarming state;

8-19 - symptoms of anxiety;

20 and above - anxiety;

25-27 - panic disorder.

Thus, the score for the non-anxiety score is close to zero. The maximum possible overall score is 56, which reflects the extreme severity of the anxiety state.

Appendix D3. Recommended drug dosages, level of evidence, and strength of recommendations for treating GAD

Generalized anxiety disorder is a mental disorder characterized by a state of persistent general anxiety that is not associated with a particular situation or object.

Symptoms of generalized anxiety disorder are persistent nervousness, muscle tension, tremors, palpitations, sweating, dizziness, and solar plexus discomfort. Often, patients have a fear of an accident or illness in themselves or loved ones, other misgivings and worries.

The disorder is most common among women. The disease often begins in childhood or adolescence.

Medication and psychotherapy are used to treat this mental disorder.

Causes of Generalized Anxiety Disorder

According to the cognitive theory of A. Beck, in persons who are prone to anxious reactions, there is a persistent distortion in the perception and processing of information. As a result, they begin to consider themselves unable to overcome various difficulties and control what is happening in the environment. The patient's attention is anxiously focused on the potential danger. On the one hand, they firmly believe that anxiety helps them adapt to the situation, on the other hand, they consider it an uncontrollable and dangerous process.

There are also theories that suggest that panic disorder is hereditary.

In psychoanalysis, this type of mental disorder is seen as the result of an unsuccessful unconscious defense against anxiety-provoking destructive impulses.

Generalized Anxiety Disorder Symptoms

Generalized anxiety disorder is manifested by frequent fears and anxiety arising about real circumstances and events that cause a person to be overly concerned about them. At the same time, patients with this type of disorder may not realize that their fears are excessive, but strong anxiety makes them feel uncomfortable.

In order to diagnose this mental disorder, it is necessary that its signs persist for at least six months, the anxiety is uncontrollable, and at least three cognitive or somatic symptoms of generalized anxiety disorder are detected (at least one in children).

The clinical manifestations (symptoms) of generalized anxiety disorder in adults and children include:

excessive anxiety and anxiety associated with events or actions (study, work), which are noted almost constantly;

difficulty controlling anxiety;

accompanying anxiety and anxiety at least 3 out of 6 symptoms:

• feeling agitated, anxious, on the verge of collapse;
• violation of concentration of attention;
• fast fatiguability;
• irritability;
• sleep disturbance;
• muscle tension.

the focus of anxiety is not associated with only one specific phenomenon, for example, with panic attacks, the possibility of being in an awkward position in public, the possibility of infection, weight gain, the development of a dangerous disease, and others; the patient is worried about many reasons (money, professional obligations, safety, health, everyday duties);

disruption of the patient's life in the social or professional sphere due to the presence of constant anxiety, somatic symptoms that lead to the occurrence of clinically significant discomfort;

the disorders are not caused by the direct action of exogenous substances or any disease and are not associated with developmental disorders.

Most patients with generalized anxiety disorder also have one or more mental disorders, including specific phobia, major depressive episode, panic disorder, and social phobia.

Patients with this disorder turn to doctors for help even in cases where they do not have other somatic and mental illnesses.

Adults with anxiety symptoms are 6 times more likely to see a cardiologist, 2 times more often - to a neurologist, 2.5 times more often - to a rheumatologist, urologist and otolaryngologist.

Treatment for Generalized Anxiety Disorder

In the treatment of generalized anxiety disorder in adults and children, adherence to the daily regimen is of great importance.

Physical activity also plays an important role. Physical activity should be such that by the evening a person would fall asleep from fatigue.

Drug treatment for generalized anxiety disorder involves the use of various groups of drugs:

• antidepressants of the sedative type. The most commonly used are amitriptyline, paxil, mirtazapine, azafen.
• antipsychotics. Unlike anxiolytics, they have such a positive property as the absence of addiction to them. The most commonly used drugs are eglonil, thioridazine, teraligen.

In some cases, low doses of seroquel, haloperidol, rispolept are used; with a pronounced demonstrative radical - low doses of chlorpromazine.

Additionally, vitamins, mood stabilizers, metabolic, nootropic drugs can also be used.

But the treatment is not limited only to medicines and the correct way of life.

Another important treatment for generalized anxiety disorder is psychotherapy.

At the onset of the disease, with good sensitivity of patients, sessions of directive hypnosis (hypnosuggative therapy) are recommended. When the patient is in a hypnotic trance, the psychotherapist instills in him the mindset for a good susceptibility to drug treatment, for recovery, for solving internal problems that are revealed during hypnoanalysis; stable attitudes are given to relieve internal stress, normalize appetite, sleep, and improve mood.

At the beginning of treatment, you need about ten sessions of individual hypnosis, then sessions can be group and repeat about 1-2 times during the month.

Cognitive-behavioral group psychotherapy is also used in treatment, which can be supportive and problem-oriented.

Biofeedback, relaxation techniques (applied relaxation, progressive muscle relaxation), breathing exercises (eg, abdominal breathing) will be helpful to some extent.

Generalized anxiety disorder is a fairly common mental disorder with an undulating chronic course that causes a decrease in the quality of life and work ability, depression and aggravating the course of somatic diseases. Therefore, this disease requires early diagnosis and appropriate therapy.

If a person has an excessive daily feeling of anxiety and anxiety for six months, we can talk about generalized anxiety disorder (GAD).

Causes of Generalized Anxiety Disorder

The exact causes of the development of the disease are unknown. It can often be found in patients suffering from alcohol dependence, as well as from panic attacks and severe depression.

This disease is quite common. According to statistics, about 3% of the world's population fall ill every year. Moreover, women get sick twice as often as men. It is common to find the disease in children and adolescents, but generalized anxiety disorder also occurs in adults.

The disease is characterized by constant anxiety and fears arising from various circumstances or events that clearly do not require such anxiety. Students, for example, may have excessive fear of exams, even if they have good knowledge and high grades. People with GAD are often unaware of the excessiveness of their fears, but the constant state of anxiety makes them uncomfortable.

To be able to diagnose with confidence GAD, symptoms must be present for at least six months, and anxiety must be uncontrolled.

Generalized Anxiety Disorder Symptoms

In GAD, the immediate cause for anxiety is not as clearly identified as in various panic attacks. The patient can be anxious for a variety of reasons. The most common concerns are about professional commitments, ongoing lack of money, safety, health, car repairs, or other day-to-day responsibilities.

Typical symptoms of generalized anxiety disorder are: increased fatigue, anxiety, irritability, decreased concentration, sleep disturbance, and muscle tension. It should be noted that most patients with GAD already have one or more psychiatric disorders, including panic disorder, depressive or social phobia, etc.

Clinically, GAD manifests itself as follows: the patient feels constant anxiety and tension caused by a series of events or actions for six or more months. He cannot control this anxiety state, and it is accompanied by the above symptoms.

To diagnose GAD in children, the presence of at least one of the six symptoms is sufficient. To diagnose generalized anxiety disorder in adults, there must be at least three symptoms.

In GAD, the focus of anxiety and anxiety is not limited to motives that are common in other anxiety disorders. Thus, anxiety and anxiety are not exclusively associated with the fear of panic attacks (panic disorder), fear of large crowds (social phobia), weight gain (anorexia nervosa), fear of separation in childhood (separation anxiety disorder), the possibility of contracting a dangerous disease (hypochondria) ) other. Anxiety causes discomfort in the patient and prevents him from leading a fulfilling life.

Typically, symptoms of generalized anxiety disorder are caused by a variety of physical disorders (for example, hypothyroidism), as well as the use of drugs or narcotic drugs.

Risk factors

The chances of getting GAD are increased when the following factors are present:

• female;
• low self-esteem;
• exposure to stress;
• smoking, using alcohol, drugs or drugs that cause addiction;
• long-term stay under the influence of one or several negative factors (poverty, violence, etc.);
• family members have anxiety disorders.

Diagnosis of Generalized Anxiety Disorder

At the consultation, the doctor performs a physical examination of the patient, asks him about the history and symptoms of the disease. Diagnosing a disease involves doing research to identify other conditions that may have triggered GAD (such as thyroid disease).

The doctor asks the patient what medications they are taking, as some of them can cause serious side effects similar to those of GAD. Also, the doctor will definitely ask if the patient is addicted to tobacco, alcohol or drugs.

An accurate diagnosis of GAD is made when the following factors are present:

• GAD symptoms continue for six months or more;
• they cause significant discomfort for the patient and prevent him from leading a full life (for example, the patient is forced to skip school or work);
• GAD symptoms are persistent and uncontrollable.

Treatment for Generalized Anxiety Disorder

Typically, treatment for generalized anxiety disorder consists of the following:

Medicines for the treatment of generalized anxiety disorder include:

• Benzodiazepines, which help relax muscles and prevent muscle tension in response to anxious thoughts. These medications are taken under the strict supervision of a physician as they can be addictive.
• Anxiety-reducing drugs such as Buspirone, Alprazolam;
• Antidepressants (mainly serotonin reuptake inhibitors).
• Beta blockers to relieve the physical symptoms of GAD.

For the most successful treatment of GAD, it is important to identify the disease as early as possible, as this can reduce the risk of severe psychological complications.

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Generalized anxiety disorder (synonyms: GAD, anxiety neurosis, anxiety reaction, anxiety state) is a mental pathology caused by chronic persistent anxiety, which does not depend in any way on the patient's living conditions and is not associated with a specific situation surrounding him.

All the signs of classic anxiety are inherent in anxiety neurosis: constant nervousness, persecution mania, tachycardia, diarrhea, excessive sweating, increased muscle tone of skeletal muscles, dizziness, uncomfortable feeling in the solar plexus area. Patients often develop an overwhelming fear of their own illness, death, including for their loved ones.

GAD is one of the most common conditions, the disorder is observed in 3-5% of the population, and the female part is susceptible to this pathology 2 times more often.

With regard to age categories, generalized anxiety disorder is more common in childhood or adolescence, and in adults who have suffered from the disorder in childhood, relapses are very frequent, when manifestations of neurosis persist throughout life.

Etiology of Anxiety Disorders

Modern psychiatrists have developed several models to explain the onset and further development of the disorder in patients.

• Sociocultural model. The modern world is dynamic, diverse and cruel, not every person is able to adapt to it and take his place without humiliating his own dignity. According to the sociocultural model, people who believe that they live or often find themselves in conditions that are dangerous to their health and life are susceptible to generalized anxiety disorder.
• Psychodynamic model. An anxious state arises at the peak of the depletion of the protective mental forces of the body, which, under the influence of constant stress and moral anxiety, do not withstand, and a person begins to perceive the world around him too subjectively.
• Humanistic model. A person gives up under the onslaught of the problems and adversities of those around him. The patient believes that his physical strength and health are no longer enough to provide himself with an independent state, the phenomenon of self-denial arises.
• Existential model. Panic fear of the imminent end of the life cycle leads to a reassessment of life values, the calculation of the remaining days before death and emotional experience based on a sense of unfulfilled duty and previously set tasks.
• Cognitive model. A psychopathological disorder based on a displacement of logical thinking due to any dysfunctions in the brain (clouding of consciousness).

Symptoms of anxiety disorder

For GAD, anxiety will be a mandatory symptom, which is characterized by the following symptoms:

• Persistence. The anxiety state lasts at least six months and periodically changes its tension, sometimes increasing, then weakening.
• Generalization. The causes of anxiety are necessarily localized, acquiring a completely laconic look. The patient can always specifically say what he fears or is afraid of panic.
• Non-fixedness. The feeling of anxiety does not in any way depend on the surrounding circumstances, the strength and number of stimuli - it arises spontaneously and for no reason, regardless of the time of year and day.

Common symptoms of anxiety disorder can be divided into three characteristic groups:

1. Mental manifestations, expressed in difficult to control long-term phenomena of anxiety and fear. This type of anxiety is clearly generalized by the specifics of the reasons.
2. Musculoskeletal tension, pronounced in tremors, convulsive manifestations, inability to relax, often with the presence of headaches in the frontal and occipital regions.
3. Hyperactivity of the autonomic nervous system, which is characterized by increased sweating, increased heart rate, hyposalivation (decreased salivation), a pressing condition in the solar plexus region and dizziness.

The manifestation of symptoms of GAD of the third group most often occurs before the age of 5 years and often degenerates into a separate disease - in children.

Hypererkinetic disorder of conduct in children is characterized by a lack of perseverance, persistence in cognitive activity. The child often proceeds to the next task without completing the first, as a result, without completing any of them. Children with this disorder exhibit excessive but unproductive activity.

In modern psychiatry, 22 symptoms of generalized anxiety are clearly identified; it is believed that if a patient has at least four of them, then there is every reason to diagnose GAD. Thanks to this list of symptoms, the genesis of anxiety disorder can be successfully localized:

Vegetative symptoms:

• tachycardia,
• increased sweating,
• muscle tremors (eyelid twitching, shaking hands)
• dry mouth, saliva viscosity.

Respiratory and Digestive System Symptoms:

• dyspnea,
• chronic lack of air
• regular pain and heaviness behind the breastbone, recurring at the same time of day,
• nausea, burning, or stomach pain.

Psychosomatic symptoms:

• dizziness, body instability when standing, fainting,
• derealization of surrounding objects, the patient has a clear feeling that he sees himself from the outside,
• fear of loss of self-control or loss of mind,
• fear of imminent death.

Common symptoms:

• feeling fever or chills
• numbness of some parts of the body, more often - asymmetric, "goosebumps".

Stress symptoms:

• increased skeletal muscle tone,
• inability to relax
• a chronic feeling of mental stress,
• difficulty swallowing.

Other symptoms:

• hyperreactivity to unexpected situations or fear,
• inability to concentrate, mental activity,
• chronic irritability
• insomnia, complete or partial.

The next grouping of GAD symptoms is based on the division according to the functional systems of the body. This approach allows you to choose the correct symptomatic treatment for generalized anxiety disorder:

• gastrointestinal symptoms: dry mouth, difficulty swallowing, pain in the stomach area, flatulence (excessive gas production), loud and frequent sounds of intestinal motility,
• respiratory symptoms: feeling of pressure in the chest, respiratory shortness of breath,
• cardiovascular symptoms: false angina pectoris, tachycardia, a feeling of no palpitations, heart rate echoes in the ears,
• urogenital symptoms: polyuria (increased urination, impotence, decreased sexual desire, menstrual dysfunction),
• symptoms of the nervous system: inability to maintain a static position of the body in space, blurred vision, dizziness, head twitching.

Unaware of the development of GAD, patients will always complain of any of the above symptoms, believing that they are developing heart disease, digestive system or migraine.

Sleep disturbances are a very common symptom in generalized anxiety. Falling asleep is always very difficult, sleep is superficial, short-term, more reminiscent of oblivion, a dip into emptiness that does not bring rest. Dreams are unpleasant, nightmarish, difficult to remember.

Outwardly, patients look tense, cautious, and sensitive to any change in the situation. The color of the skin is pale with a gray tinge. Excessive sweating at optimal ambient temperatures, especially in the armpits, feet and palms. Many patients have increased tearfulness.

Fatigue, a tendency to depression, a feeling of hopelessness and loss of one's ego are the next set of symptoms inherent in GAD, which makes it difficult to differentiate between anxiety disorder and depressive neurosis.

Differential diagnosis of GAD

To clarify the diagnosis of generalized anxiety disorder, the following pathologies with similar clinical signs should be excluded:

• diseases of somatic origin: hyperthyreidism, diabetes mellitus, pheochromocytoma. With dysfunctions of thyroid etiology, there are symptoms of an enlarged thyroid gland, atrial fibrillation, exophthalmos. Hypoglycemia and pheochromocytoma are suggested if anxiety occurs sporadically for no apparent reason. Oncological pathology is also accompanied by a state of increased anxiety, which is explained by the shock state of patients, especially in cases where their relatives died for this reason,
• a mental disorder at the level of organic damage to the central nervous system or as a result of the use of psychoactive substances, for example, amphetamine-like drugs. Alcohol or drug addiction is expressed by anxiety, which is more characteristic of the morning time of the day,
• panic disorder
• phobias,
• hypochondriacal disorder
• the classic manifestation of schizophrenia, the starting symptom of which, in the debut phase, is a feeling of anxiety,
• depressive state.

Key areas of treatment for generalized anxiety disorder

With the exception of the cognitive model of the onset of the disorder, the use of drugs for the treatment of GAD in the early stages of treatment is not recommended. In such cases, primary psychoanalysis is shown at the reception of a psychotherapist, which in 60% of cases gives a positive result.

If the analytical technique does not provide the desired therapeutic effect, it is advisable to use drug therapy in the following cases:

• first aid for overwhelming fear - benzodiazepine tranquilizers. Used carefully for no more than two months due to the possibility of addiction,
• for sleep dysfunctions, hypnotics are used in combination with sedatives,
• as symptomatic therapy with pronounced signs of vegetative manifestations - beta-blockers,
• antipsychotics are used for severe anxiety associated with aggressive behavior towards oneself or others.

On average, in half of patients, the prognosis for generalized anxiety disorder is favorable, provided that adequate therapy, corresponding to a specific etiology, has been carried out. In the second half, GAD very often transforms into depressive psychosis, which makes it possible to determine the prognosis as cautious. The effectiveness of therapy and the level of predictability in such a disorder can be determined only in the last stages of treatment. It should also not be forgotten that the propensity to relapse in GAD is relatively high.

Worry, doubt, and fear are a normal part of life. It is natural to worry about your upcoming exam, your finances, your situation at work, in your family, etc.
The difference between "normal" anxiety and generalized anxiety disorder is that anxiety in GAD can be characterized as:

• excessive
• obsessive
• permanent
• exhausting

It has been scientifically proven, for example, that after watching a report on a terrorist attack in the Middle East, a person can experience temporary feelings of uneasiness and anxiety for several minutes. In the presence of GAD, a person may feel anxiety about this all night and still worry about the worst-case scenario for several days, imagining that your hometown will become an object of terrorism, and you or your relatives (relatives, acquaintances) may become victims of this terrorist attack.

The main differences between normal and generalized anxiety in self-diagnosis.

"Normal" Anxiety

• Your anxiety does not stand in the way of your daily activities and responsibilities.
• You are able to control your anxiety.
• Your worries and troubles do not create a significant sense of distress.
• Your concerns are limited to a small number of specific, real-world problems.
• Your anxiety attacks appear for a short period of time.

Generalized anxiety disorder

• Your significant concern disrupts work rhythm, activities, social (social) life.
• Your anxiety is unmanageable.
• Your worries are very upsetting, make you tense, and are perceived as a disaster.
• You worry about all sorts of things that may not directly concern you or your family and, as a rule, expect the worst.
• Worry almost every day for at least six months.

Signs of Generalized Anxiety Disorder

Symptoms of generalized anxiety disorder are very diverse and can fluctuate in the same person over time. A person can notice both improvements and deterioration of his condition as a whole, with the course of the development of the disease. Stress, shock, negative emotions, alcohol may well not cause an acute manifestation of generalized anxiety disorder, but this aggravates the course of the disease, and the symptoms may become more severe in the future.

Not every person with generalized anxiety disorder has the same symptoms as another. As discussed, symptoms can have a myriad of variations, but most people with GAD experience a combination of the following emotional, behavioral, and physical symptoms.

Emotional Symptoms of Generalized Anxiety Disorder

• Constant worries running over your head
• Anxiety is uncontrollable, there is nothing you can do to stop anxiety
• Obsessive thoughts that form anxiety You try not to think about them, but you cannot
• Intolerance to uncertainty; You should know what will happen in the future.
• Extensive (oppressive) feelings of apprehension or fear

Behavioral Symptoms of Generalized Anxiety Disorder

• Inability to relax, enjoy the tranquility
• Difficulty concentrating
• Withdrawal from activities because you feel depressed
• Avoiding situations that create anxiety in you

Physical symptoms of generalized anxiety disorder

• Feeling of tension in the body or part of the body, a feeling of pain, heaviness, pressure
• Having trouble falling asleep or sleeping
• Feelings of severe anxiety or nervous excitement
• Stomach problems, nausea, diarrhea

Generalized Anxiety Disorder (GAD) Treatment

The core symptom of generalized anxiety disorder is chronic anxiety. It is important to understand what is the “triggering mechanism” of this massive anxiety in the body, since these mechanisms play a huge role in triggering and maintaining GAD. Therefore, first of all, a full and high-quality diagnosis is required, which will answer this basic question and determine the success in the treatment of generalized anxiety disorder.

The main, most effective method in the treatment of GAD was and remains complex therapy, which should simultaneously include several mandatory components.

Neurometabolic Treatment for Generalized Anxiety Disorder

Neurometabolic therapy, which helps the body to quickly cope with the general mood background, relieves obsessive thoughts, normalizes sleep and gives the brain the possibility of self-healing with the help of additional substances that are introduced into the body.

Psychotherapy for generalized anxiety disorder

Rational psychotherapy, which gives a person a critical attitude and awareness of the true causes of this anxiety and the obsessive thoughts that come. Gives you an understanding of what is unproductively undermining your mental and emotional energy, without leading to the solution of any specific tasks or actions. How to distinguish between productive and unproductive anxiety.

Autogenic training in the treatment of generalized anxiety disorder

Relaxation training provides an opportunity to learn to resist anxiety, disturbing thoughts. When you are relaxed, your heart rate slows down, you breathe slower and deeper, your muscles relax, and your blood pressure stabilizes. It is the opposite of anxiety and worry, which strengthens your body's relaxation responses. This is a powerful trigger for symptom relief. Regular practice is required. The nervous system will become less reactive and you will be less vulnerable to anxiety and stress. Over time, the relaxation response will become easier and easier until it comes naturally.

Group therapy for GAD

Communication within the framework of group psychotherapy. Generalized anxiety disorder is exacerbated when you feel powerless on your own. It is better to overcome this condition together with those who are experiencing the same problems. The more connected you are with other people, the less vulnerable you will feel.

GAD lifestyle

Change your lifestyle under the guidance of an experienced psychiatrist or psychotherapist. A healthy, balanced lifestyle plays a big role in the fight against GAD and fear.

Treatment of generalized anxiety disorder must be carried out under the guidance of an experienced psychotherapist who has both strong practical skills and the ability to objectively diagnose the state of the nervous system and the whole body.

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